Provider Demographics
NPI:1588809560
Name:JEREMIAH GRAFF DPM P A
Entity Type:Organization
Organization Name:JEREMIAH GRAFF DPM P A
Other - Org Name:TEXAS CENTER FOR FOOT AND ANKLE SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEREMIAH
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAFF
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:972-403-7733
Mailing Address - Street 1:2633 DALLAS PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-4703
Mailing Address - Country:US
Mailing Address - Phone:972-403-7733
Mailing Address - Fax:972-403-7744
Practice Address - Street 1:2633 DALLAS PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-4703
Practice Address - Country:US
Practice Address - Phone:972-403-7733
Practice Address - Fax:972-403-7744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-05
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXOA0054Medicare PIN
TX6211670001Medicare NSC